Verification, Disposition and Closing Cases Webinar February 1, 2012
PURPOSE of TRAINING Improve consistency in NORS reporting Provide clarifying information on Verification, Disposition and Closing Cases by: Reviewing the Basic Principles, Reviewing the Disposition Codes, Answering the Quiz coding scenarios, Answering questions related to the Quiz scenarios and answers, and Responding to other questions and examples.
Initial Comments on Coding Louise Ryan, Ombudsman Program Specialist Administration on Aging Washington, DC Shelley Hitt , Colorado State Ombudsman Chair, NASOP WINC Committee W orking to I mprove N ORS C onsistency (303) 722-0300 x 508 1-800-288-1376 skhitt@thelegalcenter.org
Basic Principles, Verifying Verifying Complaints Ombudsmen Always attempt to verify complaints; Work to resolve a complaint, whether it is verified or not. Definition of Verified It is determined after work (interviews, record inspection, observation, etc.) that the circumstances described in the complaint are generally true.
Basic Principles, Disposition Principle of 1: 1 One disposition code for each complaint, and Each complaint has one disposition code. How to choose a disposition code. Follow the direction of the resident. If resident cannot give direction, look to the resident’s representative or to the complainant to determine the resolution if consistent with the rights and interests of the resident. Disposition codes record outcomes, not activities.
Basic Principles, Closing Close a case when None of the complaints require further action from the ombudsman and Every complaint has been assigned a disposition code.
Disposition Codes Use disposition codes for closed cases. Legislative or Regulatory Action Required Policy, regulatory or legislative change needed to resolve. Not Resolved Problem not corrected or Change that was made was not to satisfaction of resident in any way
Disposition Codes Withdrawn Complaint withdrawn at the request of resident, complainant, or discontinued by the ombudsman. If significant portion was resolved prior to withdrawal, record as Partially Resolved .
Disposition Codes Referred for resolution and D.1: Final disposition not obtained D.2: Other agency failed to act D.3: Agency did not substantiate No action needed or appropriate Determined after ombudsman investigation Examples: Family complains, resident says there is no problem. Investigation indicates no change or further action is needed. Resident dies or moves and complaint is no longer relevant.
Disposition Codes Partially resolved Complaint addressed in part to the satisfaction or the resident or complainant, some problem remained. Resolved Resident is satisfied with the outcome.
Quiz Answer the following questions. Who is the complainant? What is the complaint code? Is the complaint verified? What is the disposition code? Tips Don’t over-think the scenarios. Base your answers on the facts presented. Focus on coding, not ombudsman practice and skills.
Quiz #1 A nursing home resident c omplains that the facility is keeping her money. “They’re ripping me off,” she states emphatically. You talk with the business office manager who tells you that the resident asked to have her own phone in her room. She agreed to pay for the phone out of her Personal Needs Allowance (PNA). She uses the balance of her PNA to have her hair done and purchase a few personal items. You report back to the resident. She forgot that she was paying for the phone out of her PNA. She’s glad you straightened things out. She really likes having the phone because she can keep in touch with her children and her friends.
Quiz #1 Answers Complainant: Resident Complaint Code: E-37 Verified: No Disposition: Resolved
Quiz #2 Ms. Douglas’s daughter Karen complains that the nursing home is refusing to take her mother to the dining room for the noon meal. She tells you that she has talked to the facility several times, but when she calls at noon her mother is always in her room eating her meal. You visit Ms. Douglas and explain the call received from her daughter. She tells you that she likes to eat lunch in her room because it is quiet. It is the only time she gets to be alone. The aides always try to take her to the dining room at noon, but she tells them, “No.” She reports eating her evening meal in the dining room.
Quiz #2, Answers Complainant: Relative (daughter) Complaint Code: D-27 Verified: No Disposition: No action needed
Quiz #3 You observe roaches in the nursing home. This is the fourth complaint that you have opened concerning roaches in this facility in the past year. Each time, you report to management and the corporate office. The facility has addressed the problem temporarily. However, the roaches return even though the facility has shown documentation of the regular inspections as well as pesticide records. This time, after notifying management and corporate, you decide to refer the case to the state licensing and certification agency. The licensing agency does not find any roaches the day they inspect the facility so they do not substantiate the complaint.
Quiz #3, Answers Complainant: Ombudsman Complaint Code: K-78 Verified: Yes Disposition: Referred and not substantiated (d.3)
Quiz #4 A resident tells you that an aide stole his family Bible. You speak to the aide and she explains that she put it in his top dresser drawer. It has a leather and gold cover and she put it away for safe keeping. You tell the resident the Bible is in the dresser drawer. He explains that he still cannot get it because he is unable walk across the room and he would like to read it every morning. You address the matter of the location of the Bible with the staff and the resident now has easy access to his Bible .
Quiz #4, Answers Complainant: Resident Complaint Codes: E-38 and D-27 Verified: Yes, D-27 No, E-38 Disposition: Resolved
Quiz #5 A daughter calls complaining that her mother, a nursing home resident, needs to be moved to a room closer to the nurse’s station because she feels isolated at the end of the hall. The daughter has a health care power of attorney for her mother. The mother agrees that she would feel safer in one of the two rooms near the nurses. You investigate and find that there are no empty beds in either of those rooms. The daughter insists that they move one of the other residents to make room for her mother. You visit the resident twice and she tells you she wants to forget the whole thing. Her current room is fine and all the commotion about moving is upsetting her.
Quiz #5, Answers Complainant: Relative (daughter) Complaint Code: C-22 Verified: Yes Disposition: Withdrawn
Quiz #6 During a visit at a nursing home, several residents tell you the food is often cold. You observe meal service and visit a few other residents who are also report the food is cold, so you open a case on behalf of the group of residents. You speak with dietary staff about the problem. Initially, the mealtime is adjusted to accommodate residents who are engaged in activities, but a few other residents still complain the food is cold. You continue to work on the case. The Director of Food Services agrees that new heating lamps need to be purchased and orders them and also agrees to increase staffing during peak dining times. The management follows through on ordering the equipment but there is not additional staff. You check in with residents a few weeks later and all but one is satisfied with the improvements made.
Quiz #6, Answers Complainant: Residents Complaint Code: J-73 Verified: Yes Disposition: Partially Resolved
Quiz #7 The president of the residents’ council complains about the amount of the Personal Needs Allowance (PNA) for residents receiving Medicaid. You meet with the residents’ council and explain that the PNA is determined by the state legislature. The council asks for your assistance in presenting the issue to an advocacy organization that lobbies the legislature on behalf of long-term care residents. You and the State LTC Ombudsman meet with a representative from the advocacy organization and the organization agrees to lobby for an increase in the PNA during the next legislative session.
Quiz #7, Answers Complainant: Residents Complaint Code: 0-114 Verified: Yes Disposition: Legislative action required
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